Reducing Discomfort of Leukemia Treatment

Leukemia treatment with asparaginase was less painful when administered intravenously

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) While leukemia treatments can be uncomfortable, they also save lives. Still, reducing the discomfort of these treatments remains important, especially for the youngest patients.

Acute lymphoblastic leukemia (ALL) is the most common form of leukemia (blood cancer) among children. Although complete treatment for ALL lasts about two to three years, most children are in remission.

Patients with ALL are usually treated with asparaginase by intramuscular injection (injection directly into the muscle).

A recent study found that intravenous (IV) administration of a modified form of asparaginase was safe, less painful and it required fewer application doses.

"Discuss your treatment options with your doctor."

This study was conducted by Lewis B. Silverman, MD, of the Dana-Farber Cancer Institute/Boston Children's Hospital in Boston, MA, and colleagues.

These researchers gathered data between 2005 and 2010 from 551 newly diagnosed ALL patients between 1 and 18 years old.

For the first part of the ALL treatment (induction phase), all of the patients received one dose of polyethylene glycol (PEG) asparaginase (modified form, brand name Oncaspar), during four weeks. Of the 551 patients, 526 reached remission (reduction or elimination of symptoms) and were ready for the next part of the treatment — the consolidation phase.

For the consolidation phase, 463 of the 526 patients were assigned to one of the two following regimens at random:  

  1. E. coli asparaginase (native form of asparaginase, brand name Elspar) given once a week by intramuscular injection.
  2. Polyethylene glycol (PEG) asparaginase given once every two weeks by intavenously administration.

Patients followed one of the above regimens for 25 weeks, and the researchers compared results in toxicity and efficacy between these two regimens.

The study found similar health outcomes for both regimens. The authors reported that 90 percent of participants treat with the first regimen and 92 percent of those treated with the second regimen didn’t present health events related to leukemia during the four-year observation period.

When the researchers evaluated which preparation of asparaginase (E. coli or PEG) was more toxic for the patients, they could not find differences.

The study reported that 9 percent of the patients who were treated with E. coli asparaginase and 12 percent of the patients who were treated with PEG asparaginase presented allergic reactions.

Also, 9 percent of the patients treated with E. coli asparaginase and 11 percent of the patients treated with PEG asparaginese developed pancreatitis (inflammation of the pancreas).

Furthermore, the researchers found that 11 percent of the patients treated with E. coli asparaginase and 6 percent of the patients treated with PEG asparaginase had clotting events.

The researchers also asked parents and patients about the pain level experienced during to the administration of asparaginase for both regimens. The study reported that administering PEG asparaginase IV resulted in less pain and anxiety for patients.

The study concluded that PEG asparaginase administered via IV was as safe and effective as E. coli asparaginase administered via intramuscular injection. However, IV administration of PEG asparaginase may cause less discomfort to patients.

"Demonstrating that this important agent [PEG asparaginase] can be safely administered intravenously should help to provide clinicians peace of mind that they can decrease patient discomfort without increasing risk," Dr. Silverman said.

This study was presented on December 10 at the 55th American Society of Hematology Annual Meeting in New Orleans. Some of the authors had associations with Sigma Tau Pharmaceuticals and Synta Pharmaceuticals.

Reviewed by: 
Review Date: 
December 16, 2013
Last Updated:
December 31, 2013